Percutaneous Closure of Patent Foramen Ovale (PFO)
Patent foreman ovale (PFO) is common in the adult population with a prevalence of 25 %. The foreman ovale is an anatomical structure that develops during foetal growth which allows passage of blood from the right into the left atrium. In utero, it allows blood to bypass the inactive pulmonary circulation (Fig. 6.1). At birth, there is a rapid fall in right heart pressures as the lungs expand, in addition to a rapid rise in left heart pressures, causing the foreman ovale to close. In a proportion of individuals, there is inadequate closure and a PFO is maintained. Unlike other atrial septal defects, PFO represents a ‘flap’ type defect that can remain clinically quiescent until such conditions exist to allow the flap to be opened. Important clinical situations which cause temporary or permanent increases in pulmonary artery pressures are coughing or pulmonary hypertension.
KeywordsLeft Atrium Infective Endocarditis Atrial Septal Defect Cryptogenic Cerebrovascular Accident Atrial Septal Defect Closure
ICE of positive bubble study showing bubbles crossing the inter-atrial septum (AVI 63495 kb)
Angiogram of MP-A2 catheter being positioned in left upper pulmonary vein (AVI 9354 kb)
ICE (a) Video demonstrating occluder positioning (AVI 4846 kb)
Angiographic (b) video demonstrating occluder positioning (AVI 9092 kb)
“Jiggle” test of occluder stability (AVI 10632 kb)
Device in-situ (AVI 2082 kb)
Colourflow Doppler across occluder showing absence of inter-atrial shunt (AVI 14090 kb)
- 1.Percutaneous closure of patent foramen ovale to prevent recurrent cerebral embolic events – NICE interventional procedure guidance [IPG472] Published date: December 2013 http://www.nice.org.uk/guidance/ipg472.